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An analysis of Medicare claims data found that the utilization rate of cervical spine imaging in emergency departments more than tripled from 1994 to 2012.

During the same time period, the use of radiography increased until 2002 before declining in the next decade. In the past few years, CT has overtaken radiography in detecting clinically significant findings related to spine issues.

Results were presented at the American College of Radiology’s annual meeting at the Marriott Wardman Park Hotel in Washington, DC. Gabriel Gan, of Emory University School of Medicine, was the study’s lead author.

The researchers mentioned that more than one million patients are treated each year in U.S. emergency departments for potential cervical spine issues.

For this study, the researchers evaluated the annual Medicare Physician Supplier Procedure Summary master files from 1994 to 2012. They also used separate data from the Centers for Medicare & Medicaid Services to calculate utilization rates. They only included patients with Medicare fee-for-service coverage.

Between 1994 and 2004, the volume of cervical spine radiography in the emergency department increased 50.5 percent. However, it then declined 50.2 percent between 2004 and 2012.

Meanwhile, the volume of CT scans increased 8,864 percent from 1994 through 2012, while the volumes of MR increased 1,381 percent.

In 2012, the volume of CT scans was 570,121, the volume of cervical spine radiography was 152,775 and the volume of MR was 13,979. In 1994, there were 6,360 CT scans, 203,645 radiography exams and 944 MR scans.

From 1994 to 2002, the utilization rates per 1,000 Medicare beneficiaries decreased 27 percent for radiography, increased 8,682 percent for CT scans and 1,351 percent for MR scans. On an annual basis, there was a 1.9 percent decrease in radiography and 25.9 percent increase in CT utilization.

The researchers cited a few limitations of the study, including that they used aggregate claims and could not determine causation. They also said the results may only be useful for Medicare fee-for-service beneficiaries and may not be generalizable to other patient groups.

Further, they could not assess outcomes or quality of care. In addition, they relied on self-reported CPT and specialty codes, which may have affected their findings.